Inpatient Navigator

We are seeking a highly skilled Inpatient Navigator to join our team at The Health Plan of West Virginia, Inc. The successful candidate will be responsible for conducting systematic admission, concurrent, and retrospective hospital reviews to ensure the appropriateness of inpatient admissions and continued stays.

• Conduct telephonic and/or on-site admission, concurrent or retrospective review of all inpatient admissions and observation stays.
• Enter data timely and update principle/secondary diagnoses and procedures, medical histories, and consults.
• Investigate missed admissions, obtaining pertinent details and refer to the Medical Director as appropriate.
• Determine appropriateness of admission and continued stay using established clinical criteria based on clinical algorithm and standards of operation.
• Coordinate care in collaboration with the member, family, healthcare team members, hospital utilization review, social workers, and other resources to intervene proactively to identify needed medical services, utilization and discharge issues, modifiable risk factors, educational needs, and available resources to affect individual healthcare outcomes positively.

• Registered Nurse with at least five (5) years' experience, with three (3) of those years may be work experience as a nurse's aide, LPN or other appropriate position in a clinical setting.
• Active Ohio or WV licensure upon hire, with Ohio or West Virginia multistate licensure must be obtained within the 90-day probationary period and maintained throughout employment.
• Demonstration of excellent oral, written, telephonic and interpersonal skills.
• Demonstration of proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems.

• Utilization Management, Quality Improvement, Case Management, Disease Management, or other Managed Care experience is desirable.
• Certification in an area of clinical expertise related to current work is also desirable.